The Efficacy And Safety Of Single-incision Slings For Stress Urinary Incontinence:A Network Meta-analysis

Objective: To evaluate the efficacy and safety of single-incision sling and transobturator tension-free vaginal tapes for stress urinary incontinence based on network Meta-analysis,assess which treatment is the most optimal procedure.And provide evidence for doctors to draw up a better surgical plan.Method: The database of PubMed,Embase,and Cochrane library were searched from the August 2008 to August 2018,the randomized controlled trials that comparing two or more of Minarc,Ajust,C-NDL,TFS,Ophria,TVT-O,and TOT in the treatment of female stress urinary incontinence were collected.We regard the effectiveness index,perioperative index,and complication index as the outcome of the study.Finally,we apply the software ADDIS 1.16.8 which base on bayesian principle to statistical analysis of included data.Results: A total of 21 studies with 3,428 patient were included in the analysis,all of the study were RCTs.The results of the network meta-analysis showed that there were no significant statistical difference between any two procedures in each index;and the ranking of the performance of each treatment showed that Ajust has the best subjective cure rate(Rank=0.52),while Ophira is the worst(Rank=0.67);TFS has the best objective cure rate(Rank=0.57),and the worst is Ophira(Rank=0.59);TFS required the shortest surgery time(Rank=0.40),TVT-O was the longest one(Rank=0.47),Miniarc had the least amount of bleeding(Rank=0.47),TVT-O had the most bleeding(Rank=0.37),and C-NDL had the shortest hospital stay(Rank=0.77),Ajust is the longest one(Rank=0.36);in terms of postoperative complications,TFS showed the best performance in groin pain(Rank=0.84),urinary retention(Rank=0.78),and repeated surgery(Rank=0.45);in contrast,TVT-O is the worst performer in groin pain(Rank=0.36)and urinary retention(Rank=0.58),Miniarc had the highest repeat surgery rate(Rank=0.35);Ajust has the lowest probability of mesh erosion(Rank=0.30),while Ophira is the most one(Rank = 0.45);Miniarc showed the greatest advantage in the urinary tract infection(Rank = 0.84)and de novo urgency(Rank=0.60),while C-NDL had the highest incidence of urinary tract infection(Rank=0.51),Ophira had the worst performance in de novo urgency(Rank=0.60);in terms of sexual intercourse pain,C-NDL performed best(Rank=0.79)and Ajust was the worst one(Rank=0.49).Conclusions: There are no statistically significant differences in the effectiveness,perioperative period,and complications between the seven procedures of Miniarc,Ajust,C-NDL,TFS,Ophria,TVT-O,and TOT.It explains that the above treatment of SIMS and TO-TVT are equally safe and effective.According to the probability ranking results,each of the treatment involved in the comparison has its own advantages and disadvantages;TFS and Ajust perform more better than others in cure rate,while TFS not only needs the shortest operation time,but also had the greatest advantage in postoperative groin pain,urinary retention,and repetitive surgery;meanwhile,the Ajust also performed well in mesh erosion;on the contrary,Ophria had poor performance in both cure rate and complications.Therefore,comprehensive effectiveness and safety to consider,we recommend to use TFS or Ajust preferentially for the selection of SIMS surgical treatment,and minimize the application of Ophria.